BREAST CANCER COMMUNITY
diagnosis exams

diagnosis exams

I recently had screening mammogram following by a diagnosis mammogram and ultrasound. After diagnosis exam, the 1st Dr found:
Left breast:
- Calcifications at 6:00 area and recommended to do surgical excision; although he wrote in the report that mammogram is less accurate because of parenchyma dens.  
- Did not report the findings at 12:00 and 3:00 areas.
Right breast:
- A nodule at 9:30 area and recommended for biopsy.
- Nodules at 1:00 and 3:00 area which are benign fibroadenomas.  
- Did not report findings at 9:00 and 10:00 areas.
I went to a consult section with other radiology (the 2nd Dr) to review my diagnosis mammogram and ultrasound results.  The 2nd Dr thinks my diagnosis mammogram and ultrasound were not very clear, and his findings are most opposed to the 1st Dr.  The 2nd Dr found:  
Left breast:
- Calcifications at 12:00 and 3:00 areas, but are not very clear without magnification, and recommended to have a short interval follow up.
- Did not report findings at 6:00 area.  
Right breast:
- A superficial lymph at 9:00 area, may be a cyst, recommended aspiration.
- A nodule at 3:00 area which is benign fibroadenomas (only this same as 1st Dr)
- A Lesion at 1:00 area, recommended biopsy.
- A density at 10:00 area, recommended for Ultrasound. (which the 1st Dr did not find at all)
- Also recommended for right breast sonogram.
As I described above, the 2nd Dr’s findings are most opposed to the 1st Dr’s, and so do recommendations. They may both miss something!  If their findings are the same, but had different recommendations, then I may choose one to follow.  But since they may miss something because the images are not clear and accurate and did not cover all areas to catch all findings in the diagnosis mammogram and ultrasound; in addition, since the further exams were recommended by the 2nd Dr. I think may be the further exam to clarify is a right choice?  Here are further exams I think may be needed:
- Right breast: sonogram on right breast to clarify at 9: 00, 9:30 and 1:00 areas, to see which do need biopsy or aspiration; and what is the nature of nodule at 10:00 area, which was totally missed in the previous exam.
- Left breast: An exam to obtain clearer images of calcifications (I don’t know what type of exam will have clear and more accurate images to help diagnose correctly, I will ask my physician, or an expert at Aetna has any advice?)
I believe that the further exams will have more accurate images and more conclusive and correct diagnosis and hopefully to avoid unnecessary procedures or miss out the procedures which is needed at this time.
My questions for the Dr in MedHelp are: Am I right on Further exams?  What may I get out fform those exams and:

1. Why diagnosis results are not clear, any problems or something is missing here?  What will be the better exams for my situation to avoid misdiagnosis or conflict conclusions?
2. What is your opinion for above Dr’s diagnosis and recommendations?
3. Any Dr or radiology will you suggest to get consult?
4. Which radiology or diagnosis test center will you recommended for my case?
5. Who will you recommended as a breast specialist who I can trust?
It will be greatly appreciated that if a expert from MedHelp will give me professional advice soon.
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2 Comments
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25201_tn?1255584436
First let me say that this isn't the Expert Forum where all questions are answered by the Dr.s from The Cleveland Clinic. The Diagnostic Mammogram would have involved more as well as different views of the breast tissue which could account for the differences. If you have not yet had an Ultrasound then that would be a good place to start ... or continue. I don't think any additional mammography would be a wise choice. I'm suprised that a Breast MRI wasn't mentioned ... this might be a wise option at this point to clarify things. You didn't mention (unless I missed it) a BIRAD score or the recommendation of a Surgical consult. This would usually follow such complicated readings. Another possibility would be having ALL your films read by another Radiologist ... a second opinion of sorts.
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Avatar_n_tn
Thank you so much.  Well I did Ultrasound at the same time of diagnosis mammogram. BIRAd score for 1st Dr is 4 (what is that mean?) And the Dr recommendations scare me so I went to another radiology to view my mammogram and ultrasound image, they come out diff dindings so did the recommendation.  Both seems feel not clear enough on something.  But the 1st Dr did not recommended further test, and 2nd Dr recommended ultrasound on certain area and sonogram on right.  (Sonogram is ultrasound or not?) I asked 2nd Dr if MRI will bring more clear images but he say no!  I will go to see my physician tomorrow to see what he view these.  But what is the best for next?  more test or see breast specialist?

I tried to post in 2 forum, breast cancer and radioloy, all reached limit so have to see the chance for tomorrow.

Thanks again.  If have any more ideal, please post again!
Bluskyabq
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